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PROPOSAL FOR CONTRACTORS PLANT & MACHINERY INSURANCE

(The Liability of the Company does not commence until this Proposal has been accepted by
the Company and premium paid)
(Information given herein will be treated in strict confidence)
PUT A TICK Mark wherever applicable
a Proposers Name ____________________________________________
(b)Proposers Trade or Business ___________________________________
(c)ProposersPostalAddress _______________________________________
_____________________________________________________________
(d) Location of Operation (site of property to insured)____________________
(e) Nearest Railway Station and Distance
___________________

1. Do the items listed represent the entire machinery used by you


at the above location

2. (a) Are you at present Insured : (a)


(b) If so, with whom ?
(b)

Yes

No

3. Has any Company


(a) Declined to insure any of the machinery now proposed ?
(a) Yes / No
(b) Required an increased premium or imposed special conditions? (b)Yes / No
(c) Requested for repairs or made other special stipulations for
risk improvement ?
(c)Yes / No
4. (a) Are you aware of any defects/damage existing in
the machinery.
(b) If so, give details there of

(a)Yes / No
(b)

5. Do you own or use any equipment other than that described


above working on the same site ?
6. Is any of the equipment now proposed
(a) Licensed for road use ? If so, give details

(a)________

(b) Covered by any other insurance ? If so give details (b)________


_________________________________________________________________
7. (a) Are you the owner of the proposal equipment ? If yes
will you be hiring out ?

-2(b) If the equipment is hired ;


(i) is insurance you responsibility ?
(ii) is maintenance and operation your responsibility ?
8.Are the premises where the equipment operates well guarded ?
_________________________________________________________________
9. (a) What is the site condition where the equipment will be utilised ?
(b) Are the equipment likely to operate on reclaimed or soft ground ?
(c) Are ground conditions such that equipment are exposed to
the risk of toppling over ? If so, give details ?

(d) Is the site susceptible to flood, sea damage, storm, cyclone


or other natural calamities ? If so, give details and safety
precautions taken.
_________________________________________________________________
10.
Will equipment belonging to other contractors operate on the
same site ?
11.

Do you have trained and qualified operators ? Are there any


statutory rules governing the appointment ?

12.

Which of the equipments are required to inspected and certified


for operation by statutory rules ?

13.

(a)Has your machinery sustained any damage from break down


or other cause during last 3 year ?
(a) Yes / No
(b)If so give details of damage/s and Repairing cost (b)

14. (a) Are regular periodical inspections of the machinery carried (a)Yes / No
out ?

(b) If so,by whom and at what intervals?


15.On payment of additional premium do you wish to cover :- (If yes, provide limits

of indemnity)
(a) Express freight (excluding Airfreight), overtime and Holiday
rates of wages
(a)
Rs....... No
(b) Owners surrounding property.
(c) Clearance & Removal of Debris
(d) Third Party Liability :
(i) For any one accidents
(ii)For all accidents during the period
-3-

(b)Yes Rs....... / No
(c)Yes Rs....... / No
(d)Yes (i) Rs........./No....
(ii) Rs............

________________________________________________________________
16.
Period of Insurance
From
To
SCHEDULE OF MACHINERY TO BE INSURED
GUIDE NOTES :
I. Each Machinery should be entered separately with necessary specifications as
mentioned in Schedule Column No. 3
II. The Sum Insured must be calculated on the present day new replacement value of the
Machinery to be insured including provision for packing, freight and also value of
foundations, erection cost customs duty, etc. to afford full protection under this Policy.
III. If any of the Machines is a Stand By this fact should be mentioned.
IV. All portable Machines must be so designated. All items in the open must be so described
separately.
Sr.No.

Quantity

Description
Makers
Year
Type,Model,Capacity Name
andMake
of
Machine/SerialCountry of
No.HP/KVA
Origin
Volts,AMPS,RPM
3
4
5

ofSum Insured

I/We the undersigned hereby declare that the above statements and particulars are true and
complete and I/We declare and agree this declaration and the

-4answers given above shall be held to be promissory and shall be the basis of the contract
between me/us and the Company.

Place : _______________
Dated : ______________

Proposers Signature ___________